Requires some general maintenance, construction or manual labor work experience.

Email Address

Full Name

Social Security Number

Example: 123-45-5678

Date of Birth

Example: 00/00/00

City

Street

State

Home Phone Number

Example: 123-456-7890

Business Phone Number (optional)

How were you referred?

Name of Referral Source

Do you have or have you ever had immediate family employed by the City of Anderson?

Are you legally authorized to work in the United States?

Are you below the age of 18?

Do you know of any reasons why cannot perform essential functions of the job for which you are applying with or without reasonable accommodations?

If Yes, please explain. (optional)

Have you ever been convicted of a criminal offense?

If you answered yes, please provide the following details. (optional)

Please list the date, place and nature of the offense.

First Reference Name

First Reference Occupation

First Reference Address

First Reference Phone Number

Second Reference Name

Second Reference Occupation

Second Reference Address

Second Reference Phone Number

Third Reference Name

Third Reference Occupation

Third Reference Address

Third Reference Phone Number

Highest level of educational attainment

Location

Did you graduate?

Year Graduated If (Yes, please list year) (optional)

Driving Record (optional)

Please attach Driving Record

Resume

Please attach Resume

Applicants are considered for all positions, and employees are treated during their employment without regard to their race, color, creed, religion, sex, national origin, age, marital status, sexual orientation, military status, or any non-job-related disability or medical condition. As an employer taking affirmative action to insure the removal of any possible past discrimination, and to help comply with governmental record-keeping requirements, we would appreciate your completing this form. However, COMPLETION OF THIS FORM IS STRICTLY VOLUNTARY. This data will be physically separated from the remainder of your job application before the application is considered for possible employment. This information will be kept in a confidential file, WITHOUT YOUR NAME ON IT, SEPARATE FROM YOUR APPLICATION FOR EMPLOYMENT

The City Of Anderson is an equal employment opportunity employer dedicated to a policy of nondiscrimination in employment upon any basis, including race, color, creed, religion, age,
sex, national origin, ancestry, sexual orientation, marital status, military status, or the presence of any physical or mental medical condition or disability. In reading and answering the
following questions, please keep in mind that none of the questions are intended to imply any limitations, illegal preferences, or discrimination based upon any non-job-related information.

I promise that the information provided in this employment application (and accompanying the resume, if any) is true and complete, and I understand that any false information or significant omissions may
disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I agree to immediately notify The City if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending, or during my period of employment if hired.

I authorize the investigation of all statements contained in this application (and accompanying resume, if any). I also authorize The City to contact my present employer (unless otherwise noted in this application form), past employers, and listed references. I understand that the City may request an investigative consumer report from a consumer reporting agency that includes
information as to my character, general reputation, personal characteristics, and mode of living. I understand that the investigative consumer report may involve personal interviews with my neighbors, friends, relatives, former employers, schools, and others. I also understand that under the Federal Fair Credit Reporting Act I have the right to make a written request to The
City, within a reasonable time, for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.

I authorize any person, school, current employer (except as previously noted), past employer(s), and organizations named in this application form (and accompanying a resume, if any) to provide The City with relevant information and opinion that may be useful to The City in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.

If hired, I give permission for a complete physical examination and I consent to the release to The City of any and all medical information, as may be deemed necessary by The City in judging my capability to do the work for which I am applying.

I understand that if hired and if my employment is terminated by The City for dishonesty, breach of trust, or any criminal act, the authorities may be notified and I may be criminally prosecuted. I also understand that, if hired, I may not hold other employment, nor engage in sales, investments or other activities that create a conflict of interest with my position with The City.

I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD OF TIME, and
may, regardless of the date of payment of my wages or salary, BE TERMINATED AT ANY TIME; I understand that NO PERSON IS AUTHORIZED TO CHANGE ANY OF THE TERMS
MENTIONED IN THIS EMPLOYMENT APPLICATION FORM.

IF YOU ARE HIRED, A MEDICAL EXAMINATION WILL BE REQUIRED BEFORE YOU START WORK. IF THE EXAMINATION DISCLOSES MEDICAL CONDITIONS THAT PREVENT YOU FROM SUCCESSFULLY PERFORMING THE ESSENTIAL FUNCTIONS OF THE JOB, THE CITY WILL ATTEMPT TO MAKE ACCOMMODATIONS TO ALLOW YOU TO WORK. IF NO REASONABLE ACCOMMODATIONS CAN BE FOUND, OR THEY CAUSE AN UNDUE HARDSHIP ON THE CITY, THE TENTATIVE OFFER OF EMPLOYMENT WILL BE WITHDRAWN.

AUTHORIZATION FORM FOR CONSUMER REPORTS
In connection with your application for employment (including a contract for services), understand that consumer reports or investigative consumer reports which may contain public record information may be
requested or made on you including consumer credit, criminal records, driving record, education, prior employer verification, workers compensations claims and others. These reports will include experience
information along with reasons for termination of past employment. Further, understand that information from various Federal, State, local and other agencies which contain your past activities will be requested. A
consumer report containing injury and illness records and medical information may be obtained only after a tentative offer of employment has been made. By signing below, you hereby authorize without reservation, any party or agency contacted by this employer to
furnish the above-mentioned information.

You further authorize ongoing procurement of the above-mentioned reports at any time during your employment (or contract). You also agree that a fax or photocopy of this
authorization with you signature be accepted with the same authority as the original. You have the right to make a request of HireCheck, Inc., upon proper identification and the payment of any
legally permissible fees, for the information in its files on you at the time of your request. You hereby authorize and request, without any reservation, any present or former employer, school, police
department, financial institution, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about you to furnish HireCheck, Inc. with any and all background information in their possession regarding you, in order that your employment qualifications may be evaluated.

For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report if one is obtained a request can be made. If requested and you are a California applicant, a copy of the consumer report will be sent within three (3) days of the employer receiving a copy of the consumer report.

For California applicants only, if public record information about your character, general reputation, personal characteristics and mode of living is obtained without using a consumer reporting agency, you will be
supplied a copy of this public record information within seven (7) days of the employer’s receipt unless you waive your right to obtain a copy of the consumer report.